Age-related loss of lumbar spinal lordosis and mobility--a study of 323 asymptomatic volunteers

Abstract

Background: The understanding of the individual shape and mobility of the lumbar spine are key factors for the prevention and treatment of low back pain. The influence of age and sex on the total lumbar lordosis and the range of motion as well as on different lumbar sub-regions (lower, middle and upper lordosis) in asymptomatic subjects still merits discussion, since it is essential for patient-specific treatment and evidence-based distinction between painful degenerative pathologies and asymptomatic aging.

Methods and findings: A novel non-invasive measuring system was used to assess the total and local lumbar shape and its mobility of 323 asymptomatic volunteers (age: 20-75 yrs; BMI <26.0 kg/m2; males/females: 139/184). The lumbar lordosis for standing and the range of motion for maximal upper body flexion (RoF) and extension (RoE) were determined. The total lordosis was significantly reduced by approximately 20%, the RoF by 12% and the RoE by 31% in the oldest (>50 yrs) compared to the youngest age cohort (20-29 yrs). Locally, these decreases mostly occurred in the middle part of the lordosis and less towards the lumbo-sacral and thoraco-lumbar transitions. The sex only affected the RoE.

Conclusions: During aging, the lower lumbar spine retains its lordosis and mobility, whereas the middle part flattens and becomes less mobile. These findings lay the ground for a better understanding of the incidence of level- and age-dependent spinal disorders, and may have important implications for the clinical long-term success of different surgical interventions.

Figure 1. Epionics SPINE system with the positions of the Epionics segments S1–S12.

On average, the lumbar lordosis is covered by the first six segments (shown in red). Middle: Schematic sketch of the definition of the determined segmental angle is shown for a single exemplary sensor unit S2.

Figure 2. Mean values of the total lumbar lordosis (top), total range of flexion (middle) and total range of extension (bottom) in all four investigated age groups for the whole cohort (grey columns).

The red lines represent males and the blue lines females. Error bars represent the standard deviation.

Figure 3

Mean values of the segmental lordosis for the Epionics segments S1 to S6 in all investigated age groups (A). Males (above) and females (below) are shown separately. Error bars represent the standard deviation. (B): Absolute change in segmental lordosis for the Epionics segments S1 to S6 in all investigated age groups in relation to the youngest cohort (20–29 yrs) for males (above) and females (below) separately. The youngest cohort is normalised to ‘zero’ as a reference. The red area highlights the pattern of the absolute change between the oldest and youngest cohorts. (C): Relative change in segmental lordosis for the Epionics segments S1 to S6 between the oldest and youngest age groups for males (above) and females (below) separately. The youngest cohort is normalised to 100% as a reference. Values indicate the percentage of lordosis that the oldest cohort possesses in relation to the youngest cohort. The red area highlights the pattern of the relative changes between the oldest and youngest cohorts.

Figure 4. Age-related postural adaptations of the 12 Epionics segments between the oldest and youngest age cohorts for females (left) and males (right).

Figure 5

Mean values of the segmental range of flexion (RoF) for the Epionics segments S1 to S6 in all investigated age groups (A). Males (above) and females (below) are shown separately. Error bars represent the standard deviation. (B): Absolute change in the segmental RoF for the Epionics segments S1 to S6 in all investigated age groups in relation to the youngest cohort (20–29 yrs) for males (above) and females (below) separately. The youngest cohort is normalised to a value of ‘zero’ as a reference. The red area highlights the pattern of the absolute change between the oldest and youngest cohort. (C): Relative change in the segmental RoF for the Epionics segments S1 to S6 between oldest and youngest age groups for males (above) and females (below) separately. The youngest cohort is normalised to 100% as a reference. Values indicate the percentage of the RoF the oldest cohort possesses in relation to the youngest cohort. The red area highlights the pattern of the relative changes between the oldest and youngest cohorts.

Figure 6

Mean values of the segmental range of extension (RoE) for the Epionics segments S1 to S6 in all investigated age groups (A). Males (above) and females (below) are shown separately. Error bars represent the standard deviation. (B): Absolute change in the segmental RoE for the Epionics segments S1 to S6 in all investigated age groups in relation to the youngest cohort (20–29 yrs) for males (above) and females (below) separately. The youngest cohort is normalised to ‘zero’ as a reference. The red area highlights the pattern of the absolute change between the oldest and youngest cohort. (C): Relative change in the segmental RoE for the Epionics segments S1 to S6 between the oldest and youngest age groups for males (above) and females (below) separately. The youngest cohort is normalised to 100% as a reference. Values indicate the percentage of the RoE the oldest cohort possesses in relation to the youngest cohort. The red area highlights the pattern of the relative changes between oldest and youngest cohorts.